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Pathophysiology > module 9 musculoskeletal injuries > Flashcards

module 9 musculoskeletal injuries Flashcards

1
Q

strain

A

small tear to muscle or tendon

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2
Q

tendon

A

muscle to bone

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3
Q

sprain

A

injury to ligament

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4
Q

ligament

A

bone to bone

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5
Q

rupture

A

all fibers of tendon torn

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6
Q

grade 1 ligament injury

A

mild: stretching injury without instability

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7
Q

grade 2 ligament injury

A

moderate: severe injury with instability but some fibers still intact

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8
Q

grade 3 ligament injury

A

complete disruption of ligament

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9
Q

ligament injury s/s

A

sudden tearing or popping sensation
pain with wt bearing
acute swelling

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10
Q

ligament injury tx

A

relief of s/s
protect ligament
with grade 3: possible surgery

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11
Q

tendon injury

A

happens when stress placed on tendon is greater than fibers can tolerate

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12
Q

Joint capsule injury

A
  • after injury the increase in vascularity leads to fibrous tissue development and thickening of capsule
  • scarring leads to decreased ROM
  • prolonged immobility leads to decreased mobility and extensibility with subsequent loss of motion
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13
Q

effusion

A

increase in synovial fluid, can lead to stretching of capsule and ligaments

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14
Q

contracture

A

fatty tissue proliferates joint space

- increased connective tissue leads to adhesions that limit movement

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15
Q

adhesive capsulitis

A

loss of function in shoulder after injury leading to “frozen shoulder”

  • injury -> inflammation -> swelling and distention of capsule
  • prolonged immobilization -> thickening of capsule -> proliferation of fibroblasts and capsular contraction
  • tightness and loss of movement
  • excessive movement -> tearing
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16
Q

adhesive capsulitis tx

A

conservative

  • intraarticular corticosteriod injections
  • gentle stretching, PT
  • antiinflammatories
  • prevenatitive: avoid prolonged immobilization, early gentle stretching
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17
Q

Injuries to inert soft tissue structures

A

meniscal tear
labrum tear
disk tears
- all cause restrictions of joint and may -> tissue dysfunction in the form of weakness, loss of motion, pain

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18
Q

fasciae injury

A

sheath that envelopes muscle

  • cause edema and scarring
  • restrict movement -> restricted joint function
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19
Q

bursae injury

A

pockets lined with synovium between muscles and tendon/ligament

  • faulty mechanics, repetitive movement, direct trauma
  • – inflammation: bursitis: pain, disruption of movement, capsular and or muscle dysfunction related to edema
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20
Q

tendinitis

A

inflammation of tendon

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21
Q

tendinosis

A

degradation of collagen fibers

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22
Q

epicondylitis

A

inflammation of tendon where it attaches to bone

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23
Q

blunt trauma

A

soft tissue contusion or crush injury

  • compromise contractile function of muscle
  • any trauma that leads to bleeding into belly of muscle
    • potential to coagulate and calcify
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24
Q

myositis ossificans

A

abnormal calcification in muscle

prevents normal and strong contraction of muscle

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25
Q

blunt trauma tx

A

rest, ice, compression

later: surgical removal of calcification if needed

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26
Q

compartment syndrome

A

due to trauma of soft tissue caused by unyielding structure of inert tissue
muscle and nerves become ischemic
- excruciating pain and tissue damage

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27
Q

3 categories of compartment syndrome

A

decrease compartment size
increase compartment content
externally applied pressure

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28
Q

rhabdomyolysis (myoglobinuria)

A

life threatening complicatoin of severe muscle trauma with muscle cell loss

  • crush syndrome
  • compartment syndrome
  • other: malignant hyperthermia, infection, snakebite, cocaine, adverse effects of meds, long periods of immobility and unresponsiveness
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29
Q

oblique fx

A

rotational force
oblique break
no rotation around bone

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30
Q

occult fx

A

hidden

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31
Q

comminuted fx

A

more than one fx

more than 2 pieces

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32
Q

spiral fx

A

rotational force

“s” around bone

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33
Q

transverse fx

A

straight 90 degree

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34
Q

greenstick fx

A

pediatric population

incomplete break

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35
Q

impacted fx

A

excessive force that drives one fragment into other

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36
Q

longitudinal fx

A

split along length

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37
Q

stress fx

A

failure of one cortical surface of bone, often caused by repetitive action (running)

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38
Q

avulsion fx

A

separation of a small fragment of bone at site of attachment of ligament or tendon

39
Q

fx in peds

A

through shaft of long bone, could stimulate bone growth

  • pay attention to alignment
    • bony overgrowth or skeletal arrest an lead to different limb lengths
  • near joint line: potential for disruption of long bone growth
40
Q

crush/ compression

A

associated with cancellous bone

  • doesn’t tolerate
  • buckles then cracks
41
Q

displaced fx

A

ends separated

42
Q

non-displaced fx

A

fragments aligned

43
Q

depressed fx

A

displaced below the level of the surface of the bone, usually in skull

44
Q

complete fx

A

through whole thickness of bone

45
Q

incomplete fx

A

cortex buckles or cracks, bone continuity not disrupted

46
Q

compound

A

open

47
Q

simple

A

closed

48
Q

open/compound fx classification

A

type 1: wound < 1cm, minimal contamination
- simple transverse or oblique fx
type 2: wound > 1cm, moderate contamination
- moderate comminution or crush fx
type 3: large amount of contamination
- fx severely comminuted and unstable
- soft tissue damage; muscle, skin, neurovascular
type 3A: soft tissue coverage of fx is sufficient
type 3B: loss of soft tissue + periosteal stripping and bone exposure
type 3C: arterial injury requiring repair, regardless of extent of soft tissue injury

49
Q

fx tx

A 
initial
- ice
- elevation
- immobilization
2 main goals
- reduction
- immobilization
-- cast, splint
surgical intervention
- open fx
- debridement
- multiple injuries
interarticular: surgical fixation to perserve joint
prophylatic abx and tetnus
rehab
50
Q

complications of fx

A 
delayed healing
- delayed union
- malunion
- nonunion
osteonecrosis
osteomyelitis 
comartment syndrome
fat emboli syndrome 
DVT and PE
neurovascular injury
51
Q

osteonecrosis

A

compromised circulation -> ischemia and death of bone tissue

52
Q

osteomyelitis

A

severe bone infection, can occur with open fx -> invasion of bacteria into bone

53
Q

compartment syndrome breakdown

A

-accumulation of pressure
- injury to tissue surrounding bone -> soft tissue inflammation-> swelling sometimes hemmorhage
- increase pressure within compartment -> decreased blood flow related to arterial damage -> hypoxia -> capillary integrity decreased -> colloids and fluid escape -> increased swelling -> increased pressure
if tissue pressure > vascular pressure -> vascular collape -> impeding blood flow -> hypoxia -> edema

54
Q

compartment syndrome tx

A

emergent decompression: fasciotomy to perserve limb

55
Q

compartment syndrome s/s

A 
pain
pallor
paralysis
no pulse
parethesia
56
Q

fat emboli syndrome

A

after fx fat particles release form bone marrow into bloodstream and lodge in lungs
-24-72 hours after trauma

57
Q

fat emboli syndrome s/s

A 
SOB
tachypnea
hypoxemia
fine petechial rash
altered mental status
dx: 
- CT or ventilation-perfusion scan 
- CXR nml
58
Q

DVT and PE

A

thrombus in extremity, clot fragments break off and lodge in lung
highest risk:
- pelvic or long bone fx with >5 days immobilization
- obese pt
- hx DVT
- increased risk of clotting

59
Q

DVT and PE tx

A

ventilatory support
anticoags
compression device
early mobilization

60
Q

neurovascular injury

A 
may be due to fx or tx of fx 
occuring at time of trauma
- force causing fx
- hemorrhage
- joint dislocation 
- body position after trauma
related to tx:
- moving or splinting fx
- manipulation during reduction 
- cast of splint
- hemorrhage or edema
61
Q

dislocation

A

displacement of bone from normal position

- articulating surfaces lose contact

62
Q

subluxation

A

displacement of bone from normal joint location

- articulating surfaces partially lose contact

63
Q

dislocations and subluxations reason and s/s

A 
occur when forces cause one aspect of joint to move beyond normal anatomical limit
s/s:
- pain
- alteration of normal contour
- change in length of extremity
- loss of normal mobility
64
Q

osteopenia

A

condition where bone mineral density is lower than normal

65
Q

osteoporosis

A

loss of both compact and spongy bone

  • bone resorption exceeds bone growth
  • bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass
  • presence of a fragility fx: falls form own height of standing
    types:
  • postmenopausal
  • secondary
  • regional
66
Q

causes of osteoporosis

A

menopause
- decrease estrogen -> increased osteoclast activity
effects of aging
- decreased replicative activity of osteoprogenitor cells
- decreased synthetic activity of osteoblasts
- decreased biological activity of matrix bound growth factors
- decreased physical activity

67
Q

risk factors for osteoporosis

A

nonmodifiable:
- advanced age
- female
- european or asian decent
- family hx
modifiable
- ETOH/tobacco/nutrition
- Vitamin D deficiency
- underweight/inactive
- endocrine dysfunction
- certain meds

68
Q

osteoporosis and chronic renal disease

A

pts often have parathyroid dysfunction and altered vitamin D metabolism -> decreased bone mass

69
Q

osteoporosis s/s

A

often asymptomatic till fx

  • colles fx of wrist
  • femoral or hip fx
  • vertebral comression fx
  • kyphosis (hump)
  • decreased stature
  • impaired breathing
  • poor dentition
70
Q

osteoporosis tx

A

moderate regular exercise
PT
Ca and Vit D supplement
antiresorptive agents

71
Q

osteomalacia

A

softening of the bones due to defective bone mineralization

  • secondary to inadequate amounts of available phosphorus and Ca
  • due to overactive resorption of Ca from the bone due to hyperparathyroidism
72
Q

causes of osteomalacia

A 
nutrition deficiency
genetic abnormalities
tumor inducing
vitamin D deficiency
- malabsorption
- liver disease
- ESRD
73
Q

tx of osteomalacia

A

correction of deficiency

adequate Vitamin D, Ca, and Phosphate

74
Q

Paget disease (osteitis deformans)

A

excessive resorption of spongy bone and accelerated formation of softened bone; inadequate formation of new bone.
- disorganized, thickened, but soft bones
- most often affects the axial skeleton
Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve

75
Q

paget disease s/s

A

nothing early

  • pain: severe and persistant
  • fatigue
  • joint stiffness
76
Q

paget disease tx

A

reduce pain
prevent deformity and fracture
- calcitonin and bisphosphonates

77
Q

osteomylitis

A

infection of the bone

  • initial site of infection
  • subperiosteal abscess covers and then surrounds site -> blocked blood supply
  • sequestrum: dead bone at original site, encapsulated
  • involucrum: new bone formation around dead bone and pus. -> prevention of effective abx therapy
78
Q

exogenous osteomyelitis

A

spreads form soft tissue to adjacent bone
chronically ill, diabetic, alcoholic, immunosuppressed
S. aureus
Pasteurella multcida

79
Q

Endogenous osteomyelitis

A

pathogens carried in blood (hematogenous)
common complication of sickle cell and low O2
cutaneous, sinus, ear, dental, artificial joint infection
S. areus
H. influenzae
Salmonella
gram negative bacilli

80
Q

osteomyelitis s/s

A 
Children hematogenous
- high fever
- pain at site
- muscle spasm
- redness/swelling
- refusal to move limb
Adult hematogenous
- fever
- malaise
- night sweats
- weight loss
- anorexia 
- pain at rest
81
Q

osteomyelitis tx

A

4-6 week IV abx
debridement
bone graft

82
Q

bone tumors

A

fibroblast
- osteoblast (bone precursor)
— osteogenic tumors “osteo in name”
- chondroblast (cartilage cell precursor)
— chondrogenic tumors “chondro in name”
- fibroblast (collagen producing cell)
— collagenic tumors “fibro in name”
Reticulum
-various blood cell precursors in bone marrow
— myelogenic tumors: giant cell tumor, ewing sarcoma

83
Q

benign bone tumors

A

osteoma
chondroma
osteochondroma
osteoclastoma: giant cell tumor

84
Q

osteoma

A

small bony tumor on bone surface

  • 20 year olds
  • dull pain, worse at night
85
Q

chondroma

A

tumor made of cartilage

- found incidentally not till adulthood

86
Q

osteochondroma

A

cartilage capped tumor with bony stalk.

- found incidentally not till adulthood

87
Q

osteoclastoma/ giant cell tumor

A

may invade bone and cause bone destruction

epiphysis of femur, humorus, tibia, radius

88
Q

Malignant bone tumors

A

bone marrow: leukemia or myeloma
ewing sarcoma
metastases

89
Q

Ewing sarcome

A

malignant tumor of cartilage
children and young adults
- 5-25 years old

90
Q

metastases

A

most common malignancies found in bone

91
Q

chondrosarcoma

A 
cartilage cells 
men < women 
-30 to 60 year olds
almost 100% reoccurence
- amputation best option 
- proximal humerus
- proximal femur
- iliac crest
- ribs/scapula
92
Q

osteosarcoma

A 
formation of bone or osteoid by tumor
metaphysial region of long bones
most common primary malignant bone tumor
- 20-30 year olds
- humerus, femur, tibia
- surgical resection or amputation
93
Q

multiple myeloma

A

most common primary tumor of bone

elderly adults

Pathophysiology (80 decks)

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